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(E) Alterations of Pulmonary Function
Patho 2
113
Medical
Undergraduate 2
06/04/2014

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Term
Explain the anatomy of the Trachea
Definition
- C shaped cartilage
Term
Explain Bronchi
Definition
- Contain progessively smaller amounts of cartilage and more smooth muscle.
Term
Explain bronchioles
Definition
Contain NO cartilage, large amounts of smooth muscle.
Term
Explain Alveoli
Definition
- EXCHANGE surface,
closely associated with capillaries.
Term
What is the major function of the lungs?
Definition
- Excrete C02
- Obtain O2.
Term
What happens at the alveoli?
Definition
- Diffusion between blood and air.
Term
** Explain the steps in inspiration
Definition
1) Diaphragm moves down, ribs move up and out.
2) Chest volume increases
3) Pressure inside the chest decreases.
4) Air moves into the chest due to the pressure gradient.
Term
** Explain the steps in Expiration.
Definition
1) The diaphragm moves up, and the ribs move down and in.
2) Chest volume decreases
3) Pressure inside the chest increases
4) air moves out of the chest due to the pressure gradient.
Term
Dyspnea = ?
Definition
Difficulty breathing
Term
T or F
- A person can have both Inspiratory and Expiratory problems.
Definition
False, only one or the other, not both.
Term
Orthopnea = ?
Definition
Difficulty breathing lying down.
Term
Exertional Dyspnea = ?
Definition
Difficulty breathing with exercise.
Term
Explain Hypoventilation
Definition
- Inadequate alveolar ventilation in relation to metabolic demands (body needs).
Term
Explain Hyperventilation
Definition
Alveolar ventilation that exceeds metabolism demands (body requirements).
Term
Define Capnia
Definition
Levels of C02 in the blood.
Term
Hypoventilation --------> ?
Definition
HypERcapnia (Increased C02 in blood)
Term
Hyperventilation ----------> ?
Definition
HypOcapnia (Decreased levels of CO2 in the blood)
Term
Define Cough
Definition
- A protective reflex that cleanses the lower airway with an explosive expiration.
Term
What are some examples of a non-productive cough?
Definition
- bronchitis
- VIRAL pneumonia
- aspiration
- tumor
Term
_____ is produced with a productive cough.
Definition
Sputum
Term
What creates purulent sputum?
Definition
An infection.
Term
What creates a Non-purulent sputum?
Definition
- A non-specific irritation.
Term
What are the different types of cough medicines?
Definition
- Expectorants
- Suppresents
Term
You would use ______ to clear up a productive cough.
Definition
Expectorants
Term
You would use _______ to clear up a Non-productive cough.
Definition
Suppresants
Term
What is Cyanosis?
What can help with Cyanosis?
Definition
- Cyanosis is the bluish discoloration of the skin and mucous membrane due to increasing levels of unsaturated hemoglobin.
- Supplemental oxygen can help with cyanosis.
Term
Explain Hemoptysis.
What does it indicate?
Definition
- Coughing up blood or bloody secretions.
- Indicates a localized abnormality.
- D/DX
> Coughed up blood: bright red, alkaline
> Thrown up blood: dark red, acidic (from being in stomach acid)
Term
What is pulmonary edema?
What are the mechanisms that cause it?
Definition
- Increased fluid in the interstitial spaces of the lung.
- 3 Mechanisms that can cause it:
> L. sided CHF
> Inflammation
> Obstruction of a lymphatic duct
Term
How does L. sided CHF cause pulmonary edema?
Definition
Valvular dysfunction, Coronary Artery disease, L. Ventricular dysfunction -> Increase in L. atrial pressure -> Pulmonary Hypertension -> Pulmonary Edema
Term
How does inflammation cause pulmonary edema?
Definition
Injury to capillary endothelium ---> Increased permeability in the capillary and disruption of surfactant production by the alveoli --> leaking of fluid into interstitial spaces and alveoli ---> pulmonary edema
Term
How does blockage cause pulmonary edema?
Definition
- Lymphatic duct is blocked --> this prevents drainage from interstitial spaces ---> accumulation of fluids in interstitial spaces --> pulmonary edema
Term
What is pleaural effusion?
Definition
- The presence of fluid in the pleural space.
Term
What are the different types of fluid with pleural effusion?
Definition
- Transudate
- Exudate
> empyema
> hemothorax
> chylothorax
Term
Explain Transudate Pleural Effusion
Definition
- Hydrothorax (serious effusion)
- Edema fluid w/ very little protein and cell count
- may be grossly clear or yellowish
- Transudate "Transparent"
- Low specific gravity
Term
Explain Exudate Pleural Effusion
Definition
- Fluid that is high in protein and or cell count
- Appears grossly cloudy
- High specific gravity
Term
Explain empyema in pleaural effusion
Definition
- Numerous neutrophils are present
- pus
Term
Explain hemothorax pleural effusion
Definition
- Serosanguinous effusion
- blood
Term
Explain Chylothorax pleural effusion
Definition
- Chyle (lymphatic fluid)
Term
What is Atelectasis?
Results in?
Definition
- Loss of lung volume due to inadequate expansion of airspaces.
- Results in inadequately oxygenated blood.
Term
What are the different types of atelectasis?
Definition
- resorption atelectasis
- compression atelectasis
- microatelectasis
- contraction atelectasis
- Iatrogenic atelectasis
Term
Explain Resorbtion atelectasis
Definition
- When an obstruction prevents air from reaching distal airways.
- Air already present gradually becomes present
- Some possible causes:
>tumor
>foreign body
> mucous plug
Term
Explain Compression atelectasis
Definition
- Occurs with accumulations of fluid, air, or abnormal masses in the pleural cavity
- Takes up space -> Increased pressure in the thorax
- Pleural effusion: fluid
- pneumothorax: air
- Abnormal masses: tumor, Enlarged LN, Diaphragmatic hernia
Term
What are some selected Pulmonary diseases?
Definition
- Asthma
- COPD (chronic obstructive pulmonary diseases)
> Emphysema
> Chronic bronchitis
- Cystic Fibrosis
- ARDS (acute respiratory distress syndrome)
- Pneumonias and infections
- Lung Cancer
Term
What does obstructive lung diseases result from?
Definition
- Results from an anatomic airway narrowing
or
- from loss of elastic recoil
Term
What are some examples of obstructive lung diseases?
Definition
- asthma, emphysema, chronic bronchitis, bronchiectasis, cystic fibrosis
Term
With obstructive lung diseases you have difficulty on _______.
Definition
- Expiration
Term
What are the 3 most common obstructive lung diseases that sometimes overlap?
Definition
- Chronic Bronchitis
- Asthma
- Emphysema
Term
What characterizes restrictive lung diseases?
Definition
- Reduced compliance in the lungs so that more pressure is required to expand the lungs.
Term
What are some types of restrictive lung diseases?
Definition
- Extrapulmonary disorders
- Interstitial lung diseases
Term
Explain Extrapulmonary disorders
Definition
Affect the ability of the chest wall to act as a bellows.
Term
With restrictive lung diseases there is difficulty on _________.
Definition
- Inspiration
Term
What characterizes asthma?
Definition
- Asthma is characterized by EPSISODIC, reversible bronchospams resulting from exaggerated bronchoconstrictor response from various stimuli.
Term
With Asthma ___________ effort is increased.
Definition
Expiratory
Term
Asthma is a chronic ______ disorder of the airways.
Definition
Inflammatory
Term
What kind of clinical symptoms will you see with people who have asthma?
Definition
- Episodic dyspnea
- Coughing
- Wheezing

- Many different manifistations:
> cough-variant asthma
> asthma without a wheeze
Term
Where does the pathogenesis of asthma occur?
Definition
- All happens in the bronchioles (no cartilage, lots of muscle)
Term
ASTHMA:
- Persistent inflammation of the bronchi, is probably the underlying cause of the _________________.
Definition
Hyper-responsiveness
Term
What are the 3 components of asthma?
Definition
- Edema/inflammation
- bronchoconstriction
- mucus secreation
Term
What are the possible inducers or triggers of asthma?
Definition
- pulmonary infection
- physiological stress
- inhaled irritants
- cold air temperatures
- allergies
- exercise
Term
Explain the histopathology of asthma
Definition
1) Mucus in the lumen
2) Inflammation of the basement membrane
3) Enlargement of mucous glands
4) Hyperplasia of smooth muscle
Term
Intervals between asthmatic episodes are usually free from respiratory difficulties, although subtle respiratory deficits can be detected with a ______ _______ ________.
Definition
peak flow meter.
Term
What are the different therapies for asthma?
Definition
- bronchodilators
- anti-inflammatory drugs
- mast cell stabilizers (cromolyn drugs)
Term
What does COPD stand for?
Definition
Chronic Obstructive Pulmonary Diseases
Term
What does COPD show evidence of?
Definition
It shows evidence of persistent and irreversible air flow obstruction.
Term
What are two common conditions of COPD?
Definition
- Emphysema
- Chronic bronchitis
Term
What two conditions often co-exist and share the same pathologic mechanism?
What is that mechanism?
Definition
- Emphysema and chronic bronchitis often co-exist.
** The mechanism they both share is CIGARETTE SMOKING.
Term
What charactizes emphysema?
Definition
- Characterized by the enlargement of distal airways followed by he destruction of their walls.
Term
What conditions often complicate emphysema?
Definition
Emphysema is often complicated by chronic bronchitis and/or asthma.
Term
Explain the pathogenesis of Emphysema
Definition
1) SMOKERS have accumulations of neutrophils and macrophages in their alveoli.
2) smoking stimulates the release of ELASTASE from neutrophils.
3) smoking enhances ELASTASE activity in macrophages.
4) oxidants in cigarette smoke and oxygen free radicals DECREASE ANTIELASTASE activity.
Term
Explain Chronic Bronchitis of the obstructive category
Definition
- EXPIRATORY dyspnea
- hypersecretion of MUCUS and a persistent productive COUGH for at least 3 consecutive months in 2 consecutive years
- INFLAMMATION of the BRONCHI characterized by mucous gland hyperplasia, smooth muscle hypertrophy, bronchial wall thickening, and inflammation
- Often COMPLICATED by emphysema and/or astha
Term
What are the different types of chronic bronchitis?
Definition
- Simple Chronic Bronchitis
- Chronic Mucopurulent bronchitis
- Chronic Asthmatic bronchitis
- Chronic obstructive bronchitis
Term
Simple Chronic Bronchitis
Definition
- MUCOID sputum, with NO airflow obstruction.
Term
Chronic mucopurulent bronchitis
Definition
PUS in the sputum due to SECONDARY infections (usually bacterial).
Term
Chronic Asthmatic Bronchitis
Definition
- Hyper responsive airway and intermittent asthma.
Term
Chronic Obstructive Bronchitis
Definition
- Chronic OUTFLOW obstruction (presumably due to EMPHYSEMA)
Term
What is Cystic Fibrosis?
Definition
- An inherited disorder of the exocrine glands.
- The CF gene codes for a protein that regulates Chloride ion transport across the cell membrane.
- The result is an ABNORMALLY THICK MUCUS that tends to block ducts.
Term
Restrictive lung diseases are ________ problems.
Definition
Inspiratory
Term
What does ARDS stand for?
Definition
Acute Respiratory distress syndrome
Term
What is ARDS?
Definition
- Diffuse Alveolar Damage
Term
What characterizes ARDS?
Definition
- Decrease in arterial oxygen pressure
- Decrease in lung compliance
- Pulmonary edema with out being caused by left sided heart failure (non-cardiogenic).
Term
What causes the injury in ARDS?
Definition
- Neutrophils and macophages are generally involved in mediating the injury.
- Massive inflammatory response by the lungs.
Term
What conditions are associated with the development of ARDS? (What conditions cause ARDS?)
Definition
- Infection
> SEPSIS
> Diffuse pulmonary infections
> bacterial endotoxins
- Physical Injury
> MULTIPLE TRAUMA
> pulmonary contusions
> burns
> near drowning
- Inhaled Irritants
> smoke
> irritant gasses and toxic fumes
- Hematologic Conditions
> multiple transfusions
> DIC (Death is coming) (clotting everywhere in the body)
- Shock
- Many more
Term
Explain the pathogenesis of ARDS
Definition
Begins as either:
- Damage to the endothelial cells of the capillary
> e.g. sepsis
- Damage to the endothelial cells of the alveoli
> e.g. viral or bacterial pneumonia
> e.g. Inhilation of toxic fumes
- Or both
> inhilation of hot air -> pulmonary burns -> destroys alveolar wall
Term
Explain the pathogenesis of inflammation in ARDS
Definition
- Inflammatory mediators are released.
- Increased permeability in the alveolar blood vessels.
- loss of cells lining the alveoli
- Accumulation of FLUID in the alveolar spaces
- Hemorrhage and CLOT formation in the alveoli
- Formation of a HYALINE membrane in alveoli
- Acute respiratory failure
- Decreased production of surfactant -> atelectasis
Term
Explain the clinical features of ARDS
Definition
- Symptoms of SEVERE DISTRESS and DYSPNEA occur within 24 hours of the inciting event.
- X-rays: shows DIFFUSE CONSOLIDATION in the lungs
- Most patients need VENTILATOR THERAPY
- VERY HIGH MORTALITY:
> 1/3 die within days
> 1/3 die from pneumonia and Right sided heart failure within weeks
> 1/3 live, but with chronic respiratory problems related to fibrosis -> Contraction Atelectasis
Term
The lungs are at risk for infection when....
Definition
- Constantly exposed to contaminated air
- NASOPHARYNGEAL FLORA ARE REGULARLY ASPIRATED
- Other lung diseases make the lungs more vulnerable to infection
Term
List the pulmonary defenses:
Definition
- Filtering done by noise hairs
- Mucus blanket moved by ciliated epithelium
- IgA secreted by upper respiratory tract
- resident alveolar macrophages
- regional lymph nodes can create an immune response
Term
What are the risk factors for pulmonary infection?
Definition
- Inhibition of the mucociliary system
- Cells in the bronchial epithelium dying
Term
What are possible causes of inhibition of the mucociliary system?
Definition
- Smoking
- Chronic bronchitis
- general anesthesia
- endotrachreal intubation
- immobility
- METAPLASIA
Term
What can cause the cells in the bronchial epithelium to be destroyed?
Definition
- Enzymes or toxins released by organisms
- Inhalation of smoke or toxic gas
- Aspiration of gastric contents
- physical trauma
- some chronic diseases
Term
Define Pneumonia
Definition
An inflammation of the alveoli, interstitial tissue, and/or bronchioles due to infection by bacteria, viruses, or other pathogenic organisms, OR to irritation by chemicals or other agents.
Term
Pneumonia occurs in ________ people in the _____ each year.
Definition
- 4 million
- USA
Term
Pneumonia is the _____ leading cause of death.
Definition
- 6th
Term
Pneumonia is the most common cause of _____ due to ____.
Definition
- death
- infection
Term
What are the different classifications of pneumonias?
Definition
- Etiological classification
Infectious vs. Non Infectious
- Infectious subclassifications:
Primary vs. secondary
Bacterial, Viral, Mycotic (funal)
Nosocomial (from a hospital)
- Radiological classifications:
alveolar pneumonia
interstitial pneumonia
Term
Explain Alveolar Pneumonia
Definition
- Infection results in the accumulation of exudates in the lumen of the alveoli
- May lead to CONSOLIDATION
- Usually BACTERIAL ORIGIN
Term
Explain Interstitial Pneumonia
Definition
- Inflammation affects the alveolar SEPTA
- often diffuse & BILATERAL
- Usually VIRAL origin
Term
What are the types of alveolar pneumonia's?
Definition
- bronchopneumonia
- lobar pneumonia
Term
Explain bonchopneumonia
Definition
- Patchy distribution of inflammation that generally involves more than one lobe.
Term
Explain Lobar Pneumonia
Definition
- Airspaces of part or all of a lobe are homogenously filled with an exudate.
- -> CONSOLIDATION
Term
Explain Aspiration Pneumonia
Definition
- Caused by the inhalation of food particles, gastric contents, or other substances
- partly chemical, partly bacterial
Term
Explain Atypical Pneumonia
Definition
- Caused by mycoplasma pneumonia
- An intracellular ogranism that causes necrosis of the alveolar septal cells
Term
Explain Hypostatic Pneumonia
Definition
- Bacterial infection superimposed on pulmonary edema
- Most common in elderly, debilitated people who are confined to a bed.
Term
What are the bacterial types of pneumonia?
Definition
- Legionnaire's disease
- Pneumococcal Pneumonia
Term
Explain Legionnaire's disease
Definition
- Resides in the cytoplasm of alveolar macrophages
- Can cause massive consolidation and necrosis
Term
Explain Pneumococcal Pneumonia
Definition
- Vaccine available
- Causes inflammation which leads to alveolar edema
- The edema creates a medium for bacteria to multiply and spread and leads to consolidation
- when the bacteria lysis, it releases TOXINS.
Term
What is the official name of croup?
Definition
Acute Laryngotracheobronchitis
Term
Explain Croup (Acute Laryngotracheobronchitis)
Definition
- Children between 6 months -> 5 yrs of age
- Etiology: 85% viral
- WINTER > SSF
- subglottic area becomes obstructed
- barking, seal-like cough
- most cases resolve in 24-48 hours
- Severe cases can lead to hospitalization
Term
Explain Tuberculosis
Definition
- Etiology: Myobacterium tuberculosis
- Rate of infection for foreign born americans is 7x more likely than american born citizens.
- Spread of the organism is through AIRBORN transmission
- Inflammation occurs and causes some of the organism to be walled off into tubercles or granulomas that contain dormant organisms.
- Impaired immunity allows organism to spread throughout the body.
Term
Give details on: Squamous Cell Carcinoma
Definition
- Mostly found in guys
- Close correlation to smoking
- Easier to detect early on
- Doesn't spread until later in comparison to other types
Term
Give details on: Adenocarcinoma
Definition
- More associated with women AND nonsmokers
- weak association with smoking
- tends to be more peripheral
- sometimes associated with SCARRING
Term
Give details on: Small Cell Carcinoma
Definition
- STRONGEST correlation with smoking
- Spreads often, high chance of metastasis, 70% of people who are diagnosed have already metastasized
- rarely resectable (removable via surgery)
- w/o treatment, 1/2 the people die within 12-15 weeks
- Paranoplastic syndromes often exist (random syndrome associated with in)
Term
Give details on: Large cell carcinoma
Definition
- HIGHLY ANAPLASTIC, metastasize early on
- Worst prognosis of all 4 types
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